Otalgia (Earache)| causes and differential diagnosis of ear pain

Otalgia is a medical term that is used to describe ear pain or earache, and it is one of th main syptoms of ear diseases and disorders and there are many causes of otalgia.

1-Local causes

2-Referred Otalgia

To determine the cause of earache when the ear appears normal, the areas supplied by 5th, 7th, 9th, and 10th cranial nerves, and the 2nd and 3rd cervical nerves should be examined.

A. Oral cavity: (along the 5th nerve).

1. Dental carries, dental infections, un-erupted or impacted wisdom tooth.
2. Glossitis, stomatitis (particularly herpetic).
3. Malignant tumours of the tongue, and oral cavity.
4. Calculi of the parotid (wharton’s) duct.
5. Temporomandibular joint arthritis or dislocation.

B. Nose: (Along the 5th nerve).

  •  Sinusitis.
  •  Barotrauma of sinuses.
  •  Tumors of the nose and para nasal sinuses.

C. Pharynx: (Along the 9th nerve).

  • Tonsillitis, Quinsy, pharyngitis and retropharyngeal abscess.
  • Malignant tumours especially of the tonsils, hypopharynx and nasopharynx.
  • Postadenoidectomy and post tonsillectomy.

D. Larynx: (Along the 10th nerve).

  • Non specific laryngitis. - Epiglottitis.
  • T.B. Laryngitis. - Perichondritis.
  • Malignant laryngeal tumors.

E. Oesophagus: (Along the 10th nerve)

  • Forign Body. 
  •  Oesophagitis. 
  • Malignant tumors.

F. Cervical: (along the 2nd and 3rd cervical nerves).

  • Spondylosis. 
  • Osteoarthritis of cervical spine.

G. Miscellaneous:

  • Great vessel aneurysm. 
  • Acute thyroiditis.
  • Migraine. 
  • Angina pectoris. 
  • Long styloid process.


  • Trigeminal neuralgia (5th nerve).
  • Glossopharyngeal neuralgia (9th nerve).


This is diagnosed by exclusion of all other etiologies.
Otalgia (Earache)| causes and differential diagnosis of ear pain
Dr.Tamer Mobarak


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